Correlation Between Efficacy And Efficacy Of Vascular Complications

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Recently, several studies reported that SP TFESI is a safer alternative to the conventional SA approach, because of the risk of vascular complications [20]. This study aimed to investigate the contrast spreading pattern and its correlation with efficacy for SP TFESI. Contrast was examined for the spread to both the ventral and dorsal epidural spaces, and in cephalic and caudal directions. Clinical efficacy was significantly correlated with the cephalic spreading pattern. These results indicate that the spreading of injectate could be one of the factors determining the clinical efficacy in SP TFESI. Several previous studies reported conflicting results for differences in clinical efficacy between SA and SP TFESI. [5,15]. Desai et al.…show more content…
However, Vassiliev et al. reported preferential spread of contrast onto the medially located nerve roots (lower level of nerve root) [17,23]. Furman et al. observed an equivalent extent of spread in both the directions in the presence of 1 mL of contrast [19]. In this study, the contrast medium spread to a similar degree on our grading system in both the cephalic and caudal directions.
The vertical contrast spread pattern analysis showed a significant correlation between the cephalad spreading and clinical efficacy in the ventral expansion group. As mentioned above, Desai et al. confirmed that the more level of vertebra covered by the contrast would lead to a better clinical effect [15]. More amount of medication passed into the epidural space would eventually lead to increased flow of medication into the adjacent nerve roots as well as the nerve root of target level. In concordance to this, we assume that the positive correlation between the vertical contrast extent and therapeutic effect is a reasonable phenomenon.
In this study, since most patients who underwent L4-5 TFESI were thought to have L5 radiculopathy, the therapeutic effects might not be the direct results of TFESI on the L4 nerve root. In these cases, more medial spread of medication might lead to more successful reduction of the L5 root symptoms, because the L5 root is located medial to the L4 root at L4-5 level. According to Vassiliev’s study [17], volume-spread
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